Completed ACA-Related Filings
The Pennsylvania Insurance Department has completed its review of the following ACA-Related filings. The department's final determination is shown below, along with the date that this determination was made.
KEYSTONE HEALTH PLAN EAST
INAC-129245898
2/28/14
Keystone Health Plan East (KHPE) is increasing premium rates for the non-ACA compliant individual medically underwritten (IMUP) HMO product by 11.5% for customers enrolled on or before December 31, 2013. No new enrollment in these products is permitted after December 31, 2013. This rate action is effective from July 1, 2014 through December 31, 2014 only. About 26,000 members will be affected.
Rate Increase Justification:
- The pricing analysis for this product suggests a nearly 20.0% rate increase.
- The rate action proposed in this filing projects a Medical Loss Ratio of greater than 80%.
- Changes in Medical Service Costs: Premium rates for health care insurance are increasing as the cost of health care service rises. Health care service costs increase as health care providers increase their fees, members use more health care services and supplies, and the types of health care services and supplies change, among other factors. Nearly half of the change in health care service cost is driven by changes to health care provider fees.
- Changes in Benefits: Some plan benefits are mandated by federal and state law. Recent mandates that have increased costs include, but are not limited to: Women's Preventive Health Services (federal mandate) and Act 94 (state mandate) pertaining to coverage of expenses related to general anesthesia administered to certain patients for dental care.
- Administrative Costs: The premium rates presented in this filing make no provision for profit. Furthermore, the Affordable Care Act (ACA) imposes new taxes and other levies that are expected to represent at least 4.0% of premium for customers from July 2014 through December 2014.
QCC INSURANCE COMPANY
INAC-129245948
2/28/14
On February 28, 2014 the department approved for QCC Insurance Company (QCC) an 11.5% rate increase for its premium rates for the non-ACA compliant individual medically underwritten (IMUP) PPO product for customers enrolled on or before December 31, 2013. This rate action is effective from July 1, 2014 through December 31, 2014 only. About 13,000 members will be affected. While the rate action proposed in this filing is expected to achieve a Medical Loss Ratio of greater than 80%, the following justification was presented to substantiate the rate increase:
- Changes in Medical Service Costs: Premium rates for health care insurance are increasing as the cost of health care service rises. Health care service costs increase as health care providers increase their fees, members use more health care services and supplies, and the types of health care services and supplies change, among other factors. Nearly half of the change in health care service costs is driven by changes to health care provider fees.
- Changes in Benefits: Some plan benefits are mandated by federal and state law. Recent mandates that have increased costs include, but are not limited to: Women's Preventive Health Services (federal mandate) and Act 94 (state mandate) pertaining to coverage of expenses related to general anesthesia administered to certain patients for dental care.
- Administrative Costs: The Affordable Care Act (ACA) imposes new taxes and other levies that are expected to represent at least 4.0% of premium for customers from July 2014 through December 2014.
HIGHMARK BLUE CROSS BLUE SHIELD
HGHM-129096084
9/4/13
The rates will apply to policies that renew from December 1, 2013 through November 30, 2014. Approximately 6,500 contractholders currently are enrolled in plans to which the new rates apply. Highmark requested a 15% rate increase to previously filed rates. The Department has determined the rate increase of 12.5% is not unreasonable.
HIGHMARK BLUE CROSS BLUE SHIELD
HGHM-129098970
9/4/13
The filing was withdrawn at the company's request.
HIGHMARK BLUE CROSS BLUE SHIELD
HGHM-129099079
9/4/13
The filing was withdrawn at the company's request.
HIGHMARK BLUE SHIELD
HGHM-129099079
9/4/13
The filing was withdrawn at the company's request.
KEYSTONE HEALTH PLAN WEST
HGHM-129099073
9/4/13
The rates will apply to policies that renew from December 1, 2013 through November 30, 2014. Approximately 20,800 contractholders currently are enrolled in plans to which the new rates will apply. KHPW requested a 15% rate increase to previously filed rates. The Department has approved an increase of 9.5%.
AETNA HEALTH INSURANCE COMPANY
AETN-128947673
3/27/13
The rates will apply to policies that renew or start from August 2013 through December 2013. Approximately 138,500 members currently are enrolled in plans to which the new rates will apply. The rate increase was determined to be not unreasonable.
AETNA LIFE INSURANCE COMPANY
AETN-128947693
3/27/13
The rates will apply to policies that renew or start from August 2013 through December 2013. Approximately 7,900 members currently are enrolled in plans to which the new rates will apply. The rate increase was determined to be not unreasonable.
AETNA HEALTH, INC.
AETN-128947656
3/27/13
The rates will apply to policies that renew or start from August 2013 through December 2013. Approximately 850 members currently are enrolled in plans to which the new rates will apply. The rate increase was determined to be not unreasonable.
AETNA HEALTH INC.
AETN-128822233
3/6/13
On behalf of the Pennsylvania Insurance Department (PID), INS Consultants, Inc. (INS) has reviewed the Aetna Health, Inc. (AHI) medical rate increase filing for Individual Advantage HMO plans.
AHI requested a 15% rate increase to previously filed rates for all non-grandfathered business renewing between May 1, 2013 and December 31, 2013, except there will be no increase for members in the HMO 50 plan. These changes are requested to become effective for new business and renewals on and after May 1, 2013. The average annual rate increase is 14.8%.
INS's review focused on the compliance of this request with Pennsylvania law and the HHS Final Rate Review Regulation Part 154 - Health Insurance Issuer Rate Increases: Disclosure and Review Requirements.
INS has reviewed the submission in its entirety. INS has noted that the Aetna's assumptions and calculations appear to be reasonable, and to be supposed by the material they provided. Aetna's projected Medical Benefit Ratio exceeds the 80% MLR guideline for individual health insurance under the ACA. INS performed an independent loss ratio projection based on the experience provided in the actuarial memorandum; the projection supported Aetna's results.
Based on our review of the relevant items listed in Section 154.301 of the HHS Final Rate Review Regulation and the results of our independent projection, INS determined that the 14.8% average annual rate increase for Individual Advantage HMO plans is reasonable. Therefore, the PID approved the proposed average annual rate increase.
AETNA LIFE INSURANCE COMPANY
AETN-128709650
2/14/13
The consulting actuary reviewing the captioned filing on behalf of the Pennsylvania Insurance Department has determined that the Company has demonstrated that the proposed revisions translate to an average annual increase of 18.5% for PPO business and that the proposed rate revisions appear actuarially justified and is therefore not unreasonable.
The premium increase noted above is an average. Some premiums will increase by less or even go down; others will increase by more than the average. The exact rate change will depend on what benefit plan the group chooses, when the group's contract renews, the age, gender and family size for enrolling employees, and where in Pennsylvania the group is located.
Aetna Life Insurance Company has indicated that medical costs are going up and that the rate changes reflect the expected increase in cost. The primary reasons for medical cost increases are that providers raise their prices and members get more medical care. The company expects half of the medical cost increase to come from providers raising prices, a third to come from members getting more care, and the remaining portion to come from cost sharing that does not increase as quickly as medical costs.
AETNA HEALTH, INC.
AETN-128709773
2/11/13
The consulting actuary reviewing the captioned filing on behalf of the Pennsylvania Insurance Department has determined that the Company has demonstrated that the proposed revisions translate to an average increase of 17.3% for QPOS business, 15.4% for HMO and that the proposed rate revisions appear actuarially justified and is therefore not unreasonable.
The premium increase noted above is an average. Some premiums will increase by less or even go down; others will increase by more than the average. The exact rate change will depend on what benefit plan the group chooses, when the group contract renews, the age, gender and family size for enrolling employees, and where in Pennsylvania the group is located.
Aetna Health, Inc. has indicated that medical costs are going up and that the rate changes reflect the expected increase in cost. The primary reasons for medical cost increases are that providers raise their prices and members get more medical care. The company expects half of the medical cost increase to come from providers raising prices, a third to come from members getting more care, and the remaining portion to come from cost sharing that does not increase as quickly as medical costs.
AETNA HEALTH INSURANCE COMPANY
AETN-128709776
2/8/13
On behalf of the Pennsylvania Insurance Department (PID), INS Consultants, Inc. (INS) has reviewed the Aetna Health Insurance Company (AHIC) small group medical rate increase filing for QPOS business. In the latest amended filing of the subject matter, AHIC has filed for approval of rate manual revisions for the subject business as follows:
Average quarterly increases of 5.5% for January 2013, 4.9% for April, 2013, 2.0% for July 2013 and 3.0% for October 2013 and
Monthly increases of 0.3% to cover the Reinsurance Contribution (RC) and Health Insurer Fee (HIF) required by the Patient Protection and Affordable Care Act (PPACA).
Regarding the monthly increases resulting from requirements of the PPACA, the Company has indicated that they have calculated:
The impact for the 2014 RC fee, based on current regulations for policies issued in Pennsylvania, to be worth approximately 1.2% of premium and
The impact for the 2014 HIF fee based on current regulations to be approximately 2.4% of premium.
The company has demonstrated that the proposed revisions translate to an average annual increase of 17.3% for QPOS business.
In the filing, AHIC has included a copy of the rate manual and a supporting actuarial memorandum. In the actuarial memorandum, AHIC has included a discussion of the average annual increases applicable to monthly renewal cohorts, a description of the base rate development, a discussion of the effect of PPACA taxes and fees on premiums and an identification of anticipated loss ratios associated with the rate revisions.
INS's review focused on the compliance of this request with Pennsylvania law and the HHS Final Rate Review Regulation Part 154 - Health Insurance Issuer Rate Increases: Disclosure and Review Requirements.
INS has reviewed the submission in its entirety, INS performed an independent projection of future experience. Based on our review of the relevant items listed in Section 154.301 of the HHS Final Rate Review Regulation and the results of our independent projection, INS determined that the 18.5% average annual rate increase for QPOS business is reasonable. Therefore, the PID approved the proposed average annual increase of 17.3%
COVENTRY HEALTH AND LIFE INSURANCE d/b/a HEALTHAMERICA
HAPA-128573781
12/28/12
Coventry Health and Life Insurance d/b/a HealthAmerica initially submitted a rate filing to increase its Small Group PPO product by an average of 13%. While the filing was under review, HealthAmerica modified the average rate increase request to 14.7%. The Department foiund the proposed rate increase was unreasonable. The Department's review indicated that an average increase of 11.9% was not unreasonable. The modified rate increase is justified by the experience on the form. The actual claims experience was worse than the expected claims.
HEALTHASSURANCE PENNSYLVANIA, INC.
HAPA-128570805
12/28/12
HealthAssurance Pennsylvania Inc d/b/a HealthAmerica initially submitted a rate filing to increase its Small Group PPO product by an average of 13%. While the filing was under review, HealthAmerica modified the average rate increase request to 14.7%. The Department found the proposed rate increase was unreasonable. The Department's review indicated that an average increase of 11.9% was not unreasonable. The modified rate increase is justified by the experience on the form. The actual claims experience was worse than the expected claims.
CAPITAL BLUE CROSS
CABC-128718814
12/06/12
Capital Blue Cross submitted a rate increase of 19.3% for its Individual Traditional Hospital/Medical-Surgical/Major Medical product. The Department found the proposed rate increase was not unreasonable. The rate increase is justified by the experience on the form. The actual claims experience was worse than the expected claims and the membership is declining, as this product is not accepting new members.
CAPITAL BLUE CROSS/CAPITAL ADVANTAGE INSURANCE COMPANY
CABC-128718758
12/05/12
Capital Blue Cross and Capital Advantage Insurance Company requested a 14.7% increase on their Individual Comprehensive Major Medical Program. The increase will affect approximately 4,800 insurance contracts and goes into effect on January 1, 2013. The rate increase was determined to be not unreasonable.
EVERENCE ASSOCIATION
MMAA-128647272
11/16/12
The Pennsylvania Insurance Department decided to approve an 11% average rate increase as opposed to the 18% requested by the carrier. Nationwide, the insurer's loss ratio has been over 100%. This means that for every dollar in premium taken in, it has been paying out more than one dollar in claims. This does not take into account necessary administrative expenses which increase the insurer's losses. In Pennsylvania, the Everence has been fairing somewhat better, although experience has still not been good. Last year. the Department approved an 11.1% increase. For the upcoming year, it was decided that an 11% rate increase would accommodate the insurer's need to maintain solvency and still provide reasonably priced coverage to the consumer in the midst of the current economic environment.